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Treatment of severe myoclonic epilepsy in infants with bromide and its borderline variant
1Department of Pediatrics, Tokyo Women's Medical College, Daini Hospital, Japan.
Insights
Bromides (BR) show promise as an add-on therapy for severe myoclonic epilepsy in infants (SME) and its borderline variant (BVSME). While initial seizure reduction was observed, long-term efficacy varied, with some patients experiencing side effects.
Area of Science:
- Pediatric Neurology
- Epileptology
- Pharmacology
Background:
- Severe myoclonic epilepsy in infants (SME) and its borderline variant (BVSME) are challenging epilepsy syndromes.
- Limited treatment options exist for these severe pediatric epilepsy forms.
Purpose of the Study:
- To evaluate the efficacy and tolerability of bromides (BR) as an add-on therapy in patients with SME and BVSME.
Main Methods:
- A cohort study involving 22 patients (11 with SME, 11 with BVSME) aged 8.5-183 months.
- Bromides were administered as add-on therapy with dosages ranging from 30-100 mg/kg.
- Seizure frequency, duration, and adverse events were monitored over a mean treatment duration of 19.7 months.
Main Results:
- 36% of patients with generalized tonic-clonic seizures (GTCS) showed excellent seizure reduction (>75%) and 41% moderate reduction (50-75%) at 3 months.
- Long-term efficacy at 12 months showed sustained excellent effect in 6 patients and moderate effect in 2.
- Only one patient each with partial or myoclonic/absence seizures showed a moderate effect at 12 months.
- Common side effects included drowsiness, appetite loss, and rash; one patient required dosage reduction due to acneiform rash.
Conclusions:
- Bromide add-on therapy demonstrates potential therapeutic value for severe myoclonic epilepsy in infants and its borderline variant.
- Further investigation is warranted to confirm the long-term efficacy and optimal use of bromides in these specific epilepsy populations.
Abstract:
We studied the efficacy of bromides (BR) as add-on therapy in 11 patients with severe myoclonic epilepsy in infants (SME) and in another 11 with the borderline variant of SME (BVSME). Study subjects were aged 8.5-183 months (mean 64.4 months). Longest duration of BR treatment was 37 months (range 4-37 months; mean 19.7 months). Eight of 22 (36%) of patients with generalized tonic-clonic seizures (GTCS) had an excellent effect (> 75% reduction in total seizure frequency or duration) and 9 (41%) had a moderate effect (50-75% reduction) 3 months after introduction of BR. Twelve months after initiation of BR. 5 of the patients with significant improvement were no longer responsive; ultimately, therefore, 6 had an excellent effect and 2 had a moderate effect. Of those with partial seizures (n = 5) and myoclonic/absence seizures (n = 5), only 1 patient in each group showed a moderate effect at the 12-month time-point. Dosages and serum concentrations of BR ranged from 30 to 100 mg/kg (mean 58 mg/kg) and from 64 to 159 mg/dl (mean 101 mg/dl), respectively. Of the 12 patients experiencing side effects, including drowsiness, appetite loss, and skin rash, 1 required a reduction in BR dosage because of an extensive acneiform rash on the face. The results show that BR treatment holds promise for patients with SME and BVSME and should therefore be investigated further.